Encyclopedia of

Nightmare disorder

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Definition

Nightmare disorder, which is also called dream anxiety disorder, is
characterized by the occurrence of repeated dreams during which the
sleeper feels threatened and frightened. The sense of fear causes the
person to awake.

Description

Nightmares are dreams that cause intense fear. These dreams are often
complex and fairly long. During the dream, the sleeper usually encounters
or experiences a threat to their life or safety. Nightmares are also
reported that do not involve physical danger.

As the dream progresses, the threat to the person usually increases, as
does their sense of fear. Waking usually
occurs just as the threat or danger reaches its climax. It is often
difficult for a person to return to sleep after waking from a nightmare.
Nightmares usually occur during the second half of the night's sleep.

Causes and symptoms

During the course of a nightmare the sleeper may moan, talk, or move
slightly, although these signs do not always appear. The person wakes from
the nightmare with a profound sense of fear. Waking is complete, and
usually accompanied by increased heart rate, sweating, and other symptoms
of anxiety or fear. Once fully awake, the person usually has a good recall
of the dream and what was so frightening about it. Because of the physical
symptoms of anxiety and because clarity is achieved immediately upon
waking, returning to sleep after a nightmare is often difficult. The
vividness of the recall and the prominence of the dream images in the
person's mind can also make it difficult to calm down and return to sleep.

Sometimes people may avoid going to sleep after a particularly intense
nightmare because of the fear of having another bad dream. In addition,
people may have problems falling asleep if they are experiencing anxiety
caused by the fear of having nightmares. As a result, these people may
have the signs and symptoms associated with mild sleep deprivation, such
as decreased mental clarity, problems paying attention, excessive daytime
sleepiness, irritability, or mild depression.

The causes of nightmares are not known for certain. Adults who have
nightmares on a regular basis are a small minority of the American
population. About half of these people are thought to suffer from
psychiatric disorders that cause the nightmares. Nightmares may also be
triggered by major psychological traumas, such as those experienced by
patients with
post-traumatic stress disorder
. For most patients who do not have an underlying mental disorder, the
nightmares are attributed to stress. Nightmares that occur on an irregular
and occasional basis are usually attributed to life stressors and
associated anxiety.

Some researchers think that artistic or creative people are at greater
risk for nightmares, as are people who are generally sensitive. These
people are considered to have well-developed imaginations and are very
sensitive to environmental and social factors.

Nightmares can be a side effect of some medications or drugs of abuse,
including drugs given for high blood pressure; levodopa and other drugs
given to treat Parkinson's disease;
amphetamines
, cocaine, and other stimulants; and some antidepressants. Withdrawal from
alcohol and other medications can also sometimes cause nightmares.

Demographics

The actual percentage of people that suffer from nightmare disorder is not
known, as many people do not seek treatment for it. There are, however,
estimates of the proportion of the population that experience occasional
nightmares. Many children suffer from nightmares that concern their
parents. Estimates on the number of children who have recurrent nightmares
range from 10–50%. In children, however, nightmares are not usually
associated with psychiatric illness.

The number of children experiencing nightmares decreases as they get
older. More than 3% of young adults have frequent nightmares, but only
about 1% of mature adults experience nightmares once or twice a week. Half
of the adults in the United States who experience regular nightmares have
diagnosable psychiatric illnesses. Women are estimated to have nightmares
two to four times more frequently than men. There is some uncertainty as
to whether this figure reflects an actual difference between the sexes in
the frequency of nightmares, or whether women are simply more likely than
men to report nightmares. Nightmares typically decrease in frequency as
people grow older.

Diagnosis

A
diagnosis
of nightmare disorder is usually made because the person reports the
problem to their family physician or a
psychiatrist
. There are no laboratory tests for nightmare disorder, although the
doctor may give the patient a physical examination to rule out any medical
conditions that may be causing anxiety or stress.

Nightmares are characterized by awakening with a sense of fear, a clear
recollection of the dream, and physical symptoms of anxiety. Nightmares
can occur during nighttime sleep or daytime naps. A patient experiencing
nightmares must meet the criteria listed in the
Diagnostic and Statistical Manual of Mental Disorders
to be diagnosed with nightmare disorder. The manual, which provides
guidelines used by the American Psychiatric Association for diagnosing
psychiatric disturbances, gives four distinct criteria:

• The patient must experience repeated awakenings from frightening
dreams.

• When the patient awakes, he or she must wake fully and be aware
of his or her surroundings.

• The nightmares must cause the patient distress in important areas
of his or her life.

• The nightmares cannot be directly attributed to another disorder,
or be the direct effects of medications, substance abuse, or a medical
condition.

Nightmare disorder can be confused with
sleep terror disorder
. Both disorders are characterized by an arousal during sleep when the
patient shows symptoms of anxiety or fear. Sleep terror, however, is
characterized by a partial arousal from sleep during which the patient is
generally nonresponsive. After a nightmare, the patient becomes fully
awake and is aware of his or her surroundings. During an episode of sleep
terror, a patient often gets out of bed and is active, and often screams
or cries. During a nightmare, the patient may move slightly or moan but
does not display such dramatic or active symptoms. Patients do not
remember either the sleep terror episode or what caused the fear, but
patients who have nightmares remember them with great clarity and often in
considerable detail. Such symptoms of fear or anxiety as increased heart
rate, dilated pupils, and sweating are not as dramatic in patients with
nightmare disorder as they are in patients experiencing sleep terrors.

Treatments

Nightmares that are associated with a psychiatric disorder are managed by
treating the underlying disorder. For patients without psychiatric
disorders, psychological counseling to deal with any recurring themes in
the nightmares may be helpful. Children may not require treatment for
nightmares unless the dreams are causing significant distress, as
nightmares generally resolve as children mature.

Because stress is thought to be the most common cause of nightmares,
stress reduction techniques may prove to be effective complementary
treatments. Typical relaxation techniques such as
yoga
,
meditation
, or exercise may be helpful.
Psychotherapy
can be an effective way to identify major stressors in the person's life,
and to explore ways in which they may be reduced or eliminated.

Prognosis

Nightmare disorder can be a lifelong disorder. A general improvement in
symptoms often takes place, however, as the patient gets older. Treatment
for any underlying psychological disorders can be very successful.

User Contributions:

You should also add caffine to the causes! I recently took caffine pills to stay awake in school, when i got done with school i came home to eat and while i ate i drank a highly caffinated soda and started studying. I grew tired and went to take a nap I fell asleep about 10 consecutive times, each time having a different nightmare/dream that woke me back up.

Thank you for this information. I have had nightmares and sleep terrors all my life. The descriptions you provided match my experiences exactly, right down to the muscle movements and sounds involved. I guess there is nothing I can do about them, but now, at least, I know that I am not so unusual compared to others. Yes, I have yelled to myself to WAKE UP, also, to no avail. I am 65, and have been on Paxil the last few years for depression, but that made no difference to my dreaming, although it made my depression go away completely. Is there any way to interpret what the dreams mean, what the fear means? Thanks, Lawrence.

I have the exact symptoms you describe. Sometimes my dreams are terrifying and I feel my heart racing. I sometimes see things and I think it's real but it is the dream. I wish I could never dream again, because they are never pleasant. I am very tired of it. If you find out any more about our condition, please let me know.

Try Lucid Dreaming. It took me about 2 weeks of practice to get to Lucid Dreaming. Once you have Lucid Dreaming down you can escape your nightmares, because you have a greater sense of control of your dreams and what happens in them. I've turned many nightmares to be into pleasant ones. Keeping a dream journal is one of the most important parts of Lucid Dreaming.

The basic premise of Lucid Dreaming is realizing when you are having a dream (nightmare or otherwise) and taking it for what it is - just a dream. Once you get that far you can do things to test just how lucid you are during your dreams, like attempting to walk through walls at first and then maybe even running through them. Everyone knows you can't just walk through a wall, you'll hit your head and it will hurt, but if you know *for sure* that you're dreaming you wont have any issues walking/running through one. Once you have practiced enough you should be able to start dispelling your nightmares. Imagine being eaten alive by wild dogs or something as a nightmare, when your lucid and know your dreaming, you simply dispell the dream by turning the dogs to stone, or mist or simply make them dissappear all together and dream about something else. I ussualy replace the nightmare and decide to dream about being able to fly.

There are many lucid dreaming techniques out there but here is what I've found is most effective:
1. Keep a dream diary, A small book and a pencil next to your bed.
2. Go to bed with the clear intention to dream pleasant dreams, but make it specific. What do you want to dream about, and then start thinking about it.
3. Whenever you dream anything and wake from it or are able to recall the dream the next day (even if its just bits and pieces in the beginning) write it down in your dream diary. Recalling what you have dream't will get better this way. Most people dream, EVERY night, you just don't remember it.
4. Test your lucidity, once you start lucid dreaming, by trying to do something in your dream that would otherwise not be possible, here can get creative, but progress slowly, don't start with jumping off buildings or such.
5. Lucid dreaming is best done without sleeping aids such as sleeping pills, alcohol and other narcotics

*WARNING TO SLEEP WALKERS: It is dangerous to test your lucidity if you are a sleepwalker you might really be doing it. If your a sleepwalker, ALWAYS do small test that are not life threatening, but do the ones that are hard in principle, such as levitating walking through a wall and conjuring something out of mid air or something equally non threatening*

6.Take control of your dreams. You are now the director. Take control and have fun.

I have nightmares in my sleep i experience it several times, i know i am awake but i can't open my eyes and i can't move myself...i know i am awake because i do pray after praying i'm back to normal.. how bout that??